Bispectral index monitoring in healthy, cirrhotic, and end-stage liver disease patients undergoing hepatic operation.
The purpose of this study was to assess factors influencing the end-tidal concentrations of isoflurane within a bispectral index (BIS) range of 45-55 among healthy live liver donors (n = 11), chronic hepatitis B patients undergoing hepatectomy hepatocellular carcinoma (n = 10), and end-stage liver disease patients undergoing liver transplantation (n = 7). Patients data collected prospectively were compared among the groups using one-way analysis of variance as well as univariate and multivariate techniques. The results showed that end-stage liver disease patients required the least end-tidal isoflurane concentration. Patients with hepatocellular carcinoma with cirrhosis required intermediate end-tidal isoflurane concentrations; healthy live liver donors required the highest end-tidal isoflurane concentrations to provide sufficient anesthetic depth, as monitored by a target BIS (range, 45-55). Upon multivariate analysis, liver function was the only significant factor influencing the likelihood of lowering the end-tidal isoflurane concentration by 4 hours after anesthesia induction (P = .026). In conclusion, we recommend a preset target BIS within the range of 45-55 to monitor the depth of anesthesia during partial hepatectomy and liver transplantation because end-tidal isoflurane concentration requirements are different for patients with various liver status. This strategy may protect the patients from intraoperative recall or anesthesia over-depth as a consequence of insufficient or overdose of anesthesia, respectively.
Wang
C-H
CH
Department of Anesthesiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Taiwan.
Chen
C-L
CL
Cheng
K-W
KW
Huang
C-J
CJ
Chen
K-H
KH
Wang
C-C
CC
Concejero
A M
AM
Cheng
Y-F
YF
Huang
T-L
TL
Chiu
K-W
KW
Wang
S-H
SH
Lin
C-C
CC
Liu
Y-W
YW
Jawan
B
B
D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006221:Halothane / Q000008:administration & dosage; D019694:Hepatitis B, Chronic / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery*; D017093:Liver Failure / Q000601:surgery*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000502:physiology*; D019520:Living Donors; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods
D006221:Halothane